HomeMy WebLinkAboutChange of ContractorPLANNING;& DEVELOPMENT 5tgVICI~, �h
t` �SUILDING & ZONING:DIVISION G
2NO VIRGINIA AVE CO
FORT PIERCE, FL 3499
'�- (772)-_462 ],553 ..FAX 462.1578 ;t!
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GHANGG OF CONTRACTOR $UBCUNTRAGTOR`UR CAh'CELLAT[ON°OF PERIVIT U�
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:.PLEASESELECT QNE OF TH�`FOGLOW[NG7+ `=
CHANGE OF CONTRACTOR -:Change; of Contractor is to be signed and:nokirized by'the property owner;
;and'the new contractor of record for the current permit Anew permit application mush°"also bt ;completed with new
-:contractor infoimatton and signature. A -new Notice; of Commencement must_be filed ifthe..new contractors name.
::for fob, values greater than $2,500 ($7;500 if A/C Change -out) A recorded copy .must be submitted pnor,: o, I;
commencing any`'worl. There is a $50 00 fee for the Change of oin raetor.,
... ./"4R �'l�Tl•.Ti Al1T.. [:1iif l�AATTN,�'l�TAT [�.:L .a... -�a�
r changes are to: lie completed by tfie general: contractor:
nt f orm{ There,is,a $$0;00 fee forahe„Change of Sub_"
of a permit is acceptabte.,ci if no'workrha§;been;done
the owner and ggalifi6 of record There isno fee for
v-.'vni��,rJa.,i.,rt`iivi� yr rrntvui:".-. ttwwncvtaauuu,
Cancellaiion of permit is to be signed and,notariicd&by both
'cancellatton:of the p¢rinit:
f
Date
Permit
. State , icense ,_ SLt; f icensc a
New GG subcontractor..: _- /y..
Itcason for Cancellatian�WQ F'� t! Ct �� S14hP.r
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The undersigned does hereby agree to indemnify and hold harmless St Lucie Countyns,o iicers;,pgents ariil ernployees from _a1L
costs ;fees or damages ans�ng Crom.any, and all'claims ofaction focany re�so ch aris uft of thissh"_ange;of.
eontracto;/subcortractoc,oecuncellation of Eertni(Apermit eannot'be c _ e d v_or_ en performd: e,
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PSIGunTURCDF,g1VNER(o%owncr/bmldcr) SIG GGNE CON 1CTOR`(ornewGCasappLentilej
PRINT NAME c. 1'RINTNANtE"' �4
StatcafFlartda Countyoi� Kt cnc;Coanty^ State;ofElonda CoiunyofSt LLc�eCoutty!
The Yolloa�ng mswment was acigwwiedged before me this . toilowtng msliument wasuk mvledge``ji fore me this
dayof _20=.6}t dliyof "�C�Li�;.?OL t>}1��!
wfiu personall} lrnownto me C i i l Sl�✓1 who ersonaliy Ano
gar Wl has b6duiiw u ID: _ has produced as ID
- - C - t 1 nl �rir
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Signaturc;of N i ury . Date' ySlgnatur
Ravised._041.YSf16'. Y�G'.
o1�t JENNIFE'RJONNSON:;
� Commisalon # OG 115612:'.;
; dam 00fes June ls, 202t
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